REGINA — The Saskatchewan government says it will consolidate the province’s 12 health regions into one provincial health authority to be created this fall.

“What we hope it’ll mean is a more effective way of delivering health care and, if we do this in a proper manner, the average person frankly won’t notice a difference,” Health Minister Jim Reiter said at a news conference Wednesday.

“The average person is worried about frontline health care, not management structure.”

Health Minister Jim ReiterBRYAN SCHLOSSER /
Regina Leader-Post

Reiter said the move will reduce administration and duplication in services such as legal, IT or accounting.

However, the minister could not immediately provide a dollar figure for the savings or the number of jobs affected. That will be determined by a transition team, he said.

“But I think I should also note that cost savings is not the primary driver of this … This is about better and more effective ways to deliver health care to Saskatchewan,” Reiter said.

The government plans to appoint a single board of directors to govern the health authority. There could also be four zones created to co-ordinate care.

The announcement comes after the government appointed an advisory panel last summer to recommend options for fewer health regions and more efficient service.

A report released Wednesday by the panel says patients with singular, immediate needs are often well served by the health system. But it says that’s often not the case for patients with multiple chronic or complex conditions.

Panel member Dr. Dennis Kendel said health regions and services have been working like silos.

“The regional health authorities have created some boundary issues that, in fact, have sometimes hampered seamless patient care,” he said Wednesday.

The report also recommends consolidating dispatch and delivery for emergency medical services, which it says are delivered by a large number of vendors with poor integration.

There are just over 100 ambulance services in Saskatchewan.

Provincial auditor Judy Ferguson said last month that the borders for a region are artificial when it comes to ambulance service and, in some cases, service in another region may be closer to an emergency.

The panel received more than 300 submissions from the public, doctors and organizations.

The report said while there was excitement about the potential for better care, there was also concern that rural and remote communities will get lost in a bigger system and fears the restructuring is motivated by money rather than improving quality.

The province is trying to save money due to a big drop in natural resource revenue that has pushed the government’s deficit for this year close to $1 billion.

“With the Sask. Party government, consolidation is code for cuts and closures — cuts to frontline services, cuts to jobs and closures of health-care facilities,” said New Democrat health critic Danielle Chartier.

Cheryl Camillo, assistant professor at the University of Saskatchewan’s Johnson-Shoyama Graduate School of Public Policy, says how the government communicates with the public and how feedback is used will be key.

“Ultimately, your everyday patient is less concerned about how many managers there are over the health-care system and they care more about the services they receive,” Camillo said.

“But they need to understand where to receive those services, and who they are going to need to contact to receive those services, and where they go for them.”

It’s not the first time health regions have been consolidated in Saskatchewan.

There were 32 health districts formed in 1992. In 2002, the province created the current 12 health regions plus the Athabasca Health Authority.

The system serves about 1.2 million people with a budget of $5.1 billion.

Alberta took similar action in 2008 when it rolled all regional health authorities into the centralized Alberta Health Services superboard in order to save money and improve care.

But AHS has struggled. There have been scandals over large executive payouts, questionable expense spending, organizational confusion, bureaucratic turf wars, queue-jumping and long wait lists for care.

Kendel says the Alberta experience has provided lessons for Saskatchewan, including the need for rigorous, advance planning.

“The fundamental flaw in the Alberta model is they hadn’t thought out a management structure — essentially there was a single entity, Alberta Health Services, and nobody knew the next day who was actually accountable for what,” said Kendel.

Highlights of the panel’s report:

In support of achieving a singular system that is focused on meeting patient needs through seamless, integrated and team-based care, consolidate the 12 existing RHAs into a single Provincial Health Authority with responsibility for all services governed by the existing RHA boards

To enable effective integration and co-ordination of care, create four service integration areas. The ultimate goal is to improve and enhance the patient experience across the continuum of care, including better co-ordination of patient transitions between service areas.

One of the first areas of focus of the new Provincial Health Authority and the Ministry of Health is to prioritize enhancement of team-based primary health-care across the province.

Engage with indigenous people to help inform how best to address First Nations and Metis health needs in a culturally responsive and respectful manner. In particular, appropriate representation in the governance of the Provincial Health Authority, ensure community advisory networks reflect the ethnicity and culture of the community and establish a senior administrative role within the Provincial Health Authority to be responsible for ensuring health-care services respect the Indigenous and Metis patient experience.

The Provincial Health Authority should look at opportunities for consolidation of clinical services within and across the service integration areas including lab and diagnostic imaging; services delivered by the Saskatchewan Disease Control Laboratory.

Optimize the organization of Emergency Medical Services (EMS) through the consolidation of all planning, dispatch and delivery and co-ordinate tertiary acute care services to reduce duplication and variation.

In recognition of their established expertise, ongoing service delivery with eHealth, SAHO, for information technology and related services, 3sHealth for procurement, supply chain, payroll and other related services, the Saskatchewan Association of Health Organizations (SAHO) for labour relations and the Physician Recruitment Agency of Saskatchewan for physician and health provider recruitment services will continue. A review of the governance arrangement for eHealth, SAHO, PRAS and 3sHealth should be done to ensure the most effective and efficient delivery of these services, including the potential consolidation of these entities.

The governance of the Saskatchewan Cancer Agency will reviewed to ensure cancer services are appropriately and effectively integrated with services delivered by the Provincial Health Authority. The reviews should occur within two years of the formation of the Provincial Health Authority.

It is recommended that the Health Quality Council remain as an independent organization to measure health system performance, including patient outcomes.

Establish a board to govern the Provincial Health Authority.

Clarify the roles and responsibilities of the Provincial Health Authority and the Ministry of Health for planning and operational management

Ensure physicians play an active role in the planning, management and governance of the health system

Create the capacity to standardize data collection and analysis across the health system to understand, monitor, improve and report in a timely manner on health system performance.

Task the Health Quality Council to work with the Provincial Health Authority and the Ministry of Health in monitoring and reporting on the experience and outcomes of patient care.

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